So women and girls are again being made to feel their bodies are gross...

5:45 pm - 07/03/2017

Vagina surgery 'sought by girls as young as nine'

Girls as young as nine are seeking surgery on their genitals because they are distressed by its appearance, the Victoria Derbyshire show has been told.Dr Naomi Crouch, a leading adolescent gynaecologist, said she was concerned GPs were referring rising numbers of young girls who wanted an operation.

Labiaplasty, as the surgery is known, involves the lips of the vagina being shortened or reshaped.

The NHS says it should not be carried out on girls before they turn 18.

In 2015-16, more than 200 girls under 18 had labiaplasty on the NHS. More than 150 of the girls were under 15.

Some experts fear that pornography and images viewed through social media are leading young girls to have unrealistic perceptions of how their genitals should look.

'Very upsetting'

Dr Crouch, who chairs the British Society for Paediatric and Adolescent Gynaecology, said in her work for the NHS she was yet to see a girl who needed the operation.

"Girls will sometimes come out with comments like, 'I just hate it, I just want it removed,' and for a girl to feel that way about any part of her body - especially a part that's intimate - is very upsetting."

Anna's story

Anna - not her real name - considered having labiaplasty from the age of 14.

"I just picked up from somewhere that it wasn't neat enough or tidy enough and I think I wanted it to be smaller.

"People around me were watching porn and I just had this idea that it should be symmetrical and not sticking out.

"I thought that was what everyone else looked like, because I hadn't seen any normal everyday [images] before then."I remember thinking, 'If there's surgery for it, then clearly I'm not the only one who wants this done, and maybe it won't be that big a deal.'."

She later decided not to pursue having an operation.

"I'm totally glad I didn't get it done. I didn't need it. I look totally normal. Completely and utterly normal."Paquita de Zulueta, a GP for more than 30 years, said it was only in the past few years that girls had started coming to her with concerns over the appearance of their labia.

"I'm seeing young girls around 11, 12, 13 thinking there's something wrong with their vulva - that they're the wrong shape, the wrong size, and really expressing almost disgust.

"Their perception is that the inner lips should be invisible, almost like a Barbie, but the reality is that there is a huge variation. It's very normal for the lips to protrude."

Paquita de Zulueta says some girls magnify their physical symptoms to improve their chances of having surgery.--------------

She blames the unrealistic images girls are being exposed to through pornography and social media.

"There isn't enough education and it should start really quite young, explaining that there is a range and that - just as we all look different in our faces - we all look different down there, and that's OK."

NHS England said it did not carry out the operation for cosmetic reasons, only for clinical conditions.

For the past few years clinical commissioning groups have been able to refer only patients who are experiencing physical pain or emotional distress.

But Dr De Zulueta says some girls know they need to overstate their physical symptoms to get the surgery.

"There is awareness that they're more likely to get the operation if they say it's interfering with sex, with sport, they feel that will tick that box."

'Parallels with FGM'

Dr Crouch believes labiaplasty should be given only to girls who have a medical abnormality.

"I find it very hard to believe there are 150 girls with a medical abnormality which means they needed an operation on their labia," she said.

She added there were uncomfortable parallels between this surgery and female genital mutilation (FGM), which is illegal in the UK.

"The law says we shouldn't perform these operations on developing bodies for cultural reasons. Current Western culture is to have very small lips, tucked inside. I see this as the same thing".

Seeking advice

Dr Gail Busby, lead adolescent gynaecologist at St Mary's Hospital, says it is important for girls and their parents to remember:

§ In adolescence, the labia are still growing - with the inner lips growing first - so it is normal for them to appear prominent. Girls should not compare themselves to adult women§ By age 18, the outer lips will have grown. If girls can hold off seeking an operation until adulthood, their genitals' appearance will have changed - removing the initial reason for wanting surgery§ Surgery will probably lead to scarring and - as the labia are still developing - could lead to it becoming asymmetrical in adulthood§ Do not feel alone. Half the girls in your class will be in the same position, it is a normal part of development - it is just that no-one talks about it openly§ If parents wish to allay fears, take your daughter to a GP§ In some instances, if there are deeper concerns regarding body image, it may help to create some coping strategies

Body image adviceThe majority of labiaplasties are done by private cosmetic surgeons on women over 18.

After six years of wishing she looked better below the belt, Alyssa recently shelled out $4,200 to have part of her labia removed.

"Esthetically, there's nothing hanging, there's nothing really excess in that area so it does look better," said Alyssa, whose name has been changed to protect her privacy.

The procedure she got done, known as labiaplasty, was performed in 35 minutes under local anesthetic at the Toronto Cosmetic Clinic and is part of a trend toward cosmetic gynecology being seen in Canada and the U.S.

Cosmetic surgeons argue the procedures can help women build confidence and resolve problems with sexual dysfunction.

But critics say the desire to get labia changed is driven by unattainable standards set by the prolific porn industry, and there is little evidence to support any claims the procedures provide women with any benefit.

The clinic's managing director, Sina Kashani, says the procedure has spiked in popularity since it was first offered in 2005.

Patients can choose from a range of styles — from the "Barbie," "for a perfectly smooth look," to the "more conservative" "peek-a-boo."

Cosmetic surgeons say demand for surgeries like labiaplasty has increased rapidly in the past few years. (Credit: iStock/Getty Images)-----------------------

Four-fold increase

"Patience is the key when it comes to recovery," Alyssa said. "The first couple of weeks is uncomfortable because it's a very, very sensitive area."

The Toronto clinic offers a range of cosmetic gynecology procedures that also include vaginoplasty to tighten the vaginal muscles, labia puffing to increase the outer labia, and hymenoplasty to repair broken hymens.

While these surgeries aren't new, Kashin says the procedures have increased four-fold since the clinic started offering them and it's now one of several busy plastic surgery centres in Toronto that does so.

Dr. Robert Moore has clinics in Atlanta, Beverly Hills and Dubai that specialize in reconstructive and cosmetic vaginal procedures, which they've been performing for the past 15 to 20 years.

"This isn't just a trend," Moore said at the conference. "There's actually more science behind this that the members of the society want to know about."

Moore said cosmetic gynecology first began with vaginal rejuvenation, which is often performed on women who suffer from a prolapsed uterus, urinary tract or rectum post-childbirth and may experience pain during intercourse as a result.

"In the past we kind of just said, well, you're a mom now. If things get worse and you start leaking urine all over yourself come see us, we can then do something about it," he said.

"Sexual dysfunction is a real problem, why do we have to wait for things to get so extreme?"

The procedure is now also performed on older women who want to tighten their vaginas, also usually after having had children, and not necessarily because of any problems with pain.

Hymen repair is performed mainly for women who are preparing to marry, but is only a small portion of the business.In the past five to 10 years, the greatest growth in the specialty cosmetic field has been labiaplasty, which also has some roots as a medically necessary procedure — it is sometimes done to help women who experience pain because of friction caused by unusually large labia.

But Moore admits the surgery is often performed on women who feel uncomfortable being sexual because they don't like how their genitals look.

Todd says she regularly has patients ask her about altering their labia, and although they are of all ages, the majority of them are under 19.

"I do feel that there's an increased focus on the appearance of genitals as this is pushed forward by increased access to images on the internet as well as in pornography," Todd said.

"I feel as a medical community it behooves us to know and reassure women that the majority of them do fall well within normal limits."

One of Todd's tactics when patients come in asking about the procedure is to show them medically or feminist-oriented websites like the U.K.'s Great Wall of Vagina to demonstrate the wide variety of vulval shapes and sizes.

She also screens her patients for mental health issues, and warns them of the risks of surgery — which include infection, scarring, nerve damage and increased pain.

As for the science supporting cosmetic procedures for sexual dysfunction, Todd says plastic surgery often suffers from publication bias — the industry is more likely to only publish studies with positive results and not the negative ones.Instead, she says proven results for post-partum problems include pelvic floor exercises and physiotherapy.

Not just the increasingly unrealistic depiction of women's bodies in porn, but the increased availability of porn. When I was a kid, there were ubiquitous displays of Playboy and Playboy-esque frontal nudity, which fed into the move toward breast enlargement surgeries. But porn displaying genitals? Everyone knew it existed, but it was not something that a child, especially a girl child, was likely to see on a frequent basis, and men kept their mouths shut about having it or watching it.

At the same time, casual same-sex nudity was more common. Locker rooms had no privacy at all, and neither did gym showers. Summer camp meant all of us, including our counselors, dressing and undressing together. I didn't know what the nether regions of porn actresses looked like, but I saw enough of my peers' that I knew we weren't enough different to care. And as for looking at myself, it didn't occur to me to do that unless I was doing a tick-check after those camping trips. I wonder how I would have thought about myself if I had been steeped in the hardcore porn-filled/puritanical/body-shaming environment that exists now.